Referral Form - Example

Keywords / Description:

Columbus Public Health created a two sided referral card for their Adult High Risk Hepatitis Program. One side of the card has modifiable information about the immunization clinic including their office hours, address, and telephone number. The other side has patient information including the date, patient's name, identified risk, and employee signature.

Click here for NACCHO's Collection of Adult Hepatitis B Virus (HBV) Vaccination Tools and Resources.

Toolkit:

Infectious Disease Prevention and Control Toolkit

Keyword Area:

Immunization, Infectious Diseases, Workforce Competency

Jurisdiction:

Institutional Author:

Columbus Public Health

Submitted:

12/27/2010

Modified:

07/29/2011

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